Stopping the Harm

RAISING AWARENESS  Street nurse Caroline Brunt, BCNU director of professional practice and advocacy Heather Straight and nurse Kinnon Ross at BCNU’s May convention. Brunt helped produce the 2007 documentary Bevel Up, parts of which were screened at the annual meeting. Ross shared her compelling and brave personal story of substance use disorder.

In the context of the continuing overdose crisis that is affecting families and communities across BC, the province cannot wait for action at the federal level. Immediate provincial action is warranted. As the Provincial Health Officer of BC, I recommend that the province urgently move to decriminalize people who possess controlled substances for personal use. This is a fundamental underpinning and necessary next step for the continued provincial response to the overdose crisis in BC.

DR. BONNIE HENRY

I

t goes without saying that BC's opioid overdose crisis continues to be an overwhelmingly important health issue, yet it must be said that, despite the considerable efforts made to confront the crisis, greater action is required.

BC is home to some of the most progressive harm reduction policies and practices in Canada – from a clinic that distributes prescription heroin, to opioid vending machines, to the Take Home Naloxone program and supervised injection sites. Yet the province's overdose crisis continues to be the worst in the country – almost 2,000 British Columbians died of preventable opioid overdose in 2016 and 2017. Last year, some 130 people died every month due to an overdose. Each one somebody's child, sibling, spouse, parent, colleague, friend, or client.

Since the beginning of the crisis, BCNU has been a vocal advocate for awareness and an active proponent of harm reduction and the need for change in both policy and the law in dealing with it.

That's why the union is endorsing an April report by BC's Provincial Health Officer, Dr. Bonnie Henry, which offers a single, urgent recommendation for tackling the crisis in an appropriate and responsible manner: decriminalize people who use drugs.

The PHO report reinforces a growing consensus that the criminalization and stigmatization of people who use substances has not reduced substance use, but increased health harms. It also recognizes that the toxicity of the drug supply remains a huge issue that cannot be solved by harm reduction measures alone.

The report is a decriminalization-of-people approach that looks for alternative pathways for law enforcement to link people to supports and services they may need.

"With still close to 100 drug-related deaths each month in BC, greater government action is urgently required," says BCNU President Christine Sorensen. "This report provides tangible solutions that can save lives."

A CALL TO ACTION 

Henry's recommendation was informed by current political realities. The federal government has indicated that it won't make changes to the Controlled Drugs and Substances Act under which the legal framework for illegal substance use in BC falls. As a result, Henry has recommended legislative change at the provincial level, recognizing the fact that the provincial government has the ability to decriminalize and destigmatize the people who use substances if federal government won't decriminalize the substances themselves.

Henry provides options for amending the province's Police Act in a manner that would guide law enforcement in its interaction with people who use controlled substances. This could include developing a new regulation that would prevent police officers from expending resources on the enforcement of simple possession offences under federal law.

While possession itself remains illegal, this approach creates alternative pathways for law enforcement to link people to supports and services they may need.

Caroline Brunt is a Vancouver Community College nursing instructor and former street nurse. She worked in Vancouver's Downtown Eastside for almost 20 years and understands the need for legislative change. "Our current drug laws are abstinence-based and punishment-related. That doesn't help us manage the health-care issues around substance use," she argues.

Unfortunately, Mike Farnworth, BC's minister of public safety and solicitor general, dismissed Henry's recommendation, claiming the province has no jurisdiction to act because possession of illegal substances is governed by federal law, and that he can't direct police on how to conduct operations.

Legal advocates and community organizations have since countered this claim, and have argued that enacting legislation to amend the Police Act is within the authority of the province, which bears responsibility for ensuring the health of British Columbians.

"We seriously urge Minister Farnworth to take a second look at the report," says Sorensen. "He has a responsibility to support reasoned and evidence-based proposals that could help stem the opioid crisis."

DECRIMINALIZE SUBSTANCE USE TO REDUCE STIGMA 

Community nurses know that one of the biggest problems associated with the use of controlled substances is that those who use them are often reluctant to seek treatment due to the stigma they face. This exacerbates chronic health conditions, increases isolation and further adds to the complexities of the issue. This aversion often comes from the experience of being discriminated against by the very health-care workers who are tasked with providing care.

This reality was driven home in the 2007 film Bevel Up – Drugs, Users and Outreach Nursing. The stories told and lessons to be learned are still as current and relevant as ever in the wake of today's opioid crisis. That's why BCNU recently provided financial support for the digital re-release of the documentary.

"We wanted to ensure that its messages, lessons and legacy continue to educate and inform those in the community who are helping people with substance-use disorder, and others who would like to learn more about it," says Sorensen.

Bevel Up offers education on how to provide non-judgmental communication and care and a practical understanding of how to work with people who use substances.

It was Brunt who initiated the idea for the film. She is featured in it along with colleagues and Downtown Eastside residents. She was motivated by a desire to break down the barriers of stigma that prevent people from receiving the care they need.

"We ethically and morally need to give care equally to everyone no matter what," she argues. "Yes, there are challenges to that, however the way we talk to people in the movie is really how most caregivers talk to people with cancer and cardiac issues. So why don't we all talk to people who use drugs the same way?" she asks.

It is this attitude and approach that has garnered Bevel Up accolades and acclaim. Brunt now uses the film and accompanying educational materials in her courses. "I have speakers with lived experience using drugs come in to share their stories with my students.

"The film provides another way for people to connect on a human level with what is happening with those who use drugs, and how it affects them," she says.

KEEPING THE CONVERSATION GOING 

Creating a dialogue around harm reduction was a key goal of Bevel Up. Twelve years later, the need to amplify that dialogue is stronger than ever. There is recognition that substance use isn't going away, and that as a public health issue it needs to be addressed humanely or more lives will be lost. There is also near-unanimous consensus that the "war on drugs" has been an unmitigated failure, and that we can't arrest our way out of the problem.

Simply put, the "cure" of criminalization and prohibition has led to more harm than the substances these laws were designed to control.

"That's why the PHO's recommendation should be adopted," says Sorensen. "It's also why the federal government should declare a public health emergency and take measures to increase the safety of the drug supply."

In the meantime, Sorensen says BCNU will continue to advocate for increased harm reduction, better resources for members who are working directly with communities affected by the opioid crisis and be a loud voice in the call for action by all levels of government. •

UPDATE (July-Aug 2019)